Canada

Hospitals under the knife

BARRY CAME March 17 1997
Canada

Hospitals under the knife

BARRY CAME March 17 1997

Hospitals under the knife

Canada

BARRY CAME

At Wellesley Central Hospital, the mood is grim, as bleak as the future prospects of many of the inner-city patients the venerable Toronto institution serves. Doctors, nurses, staff and a few patients have just finished watching Dr. Duncan Sinclair, chairman of the Ontario Health Services Restructuring Commission, announce on television what is likely to amount to a death sentence for the hospital. “I’m shocked, resentful,” mutters Wellesley’s chief of staff, Dr. Philip Berger, as he was absorbing the news that Sinclair’s commission wants to shut down an institution that has been a fixture in the city’s downtown core for the past 85 years.

“He says he’s acting on behalf of our children and grandchildren,” Berger complains. “Well, he’s clearly not thinking of the children and grandchildren of Wellesley’s kind of people—all those single mothers and working women, the gays and lesbians, the drug addicts, immigrants, First Nations, the poor and the homeless.”

Berger was not the only Toronto doctor grumbling aloud last week. There were plenty of similar voices raised in protest as Sinclair’s restructuring commission, after ordering the closure or mergers of 14

hospitals elsewhere in the province, finally turned its attention to the 39 publicly funded hospitals scattered across Metropolitan Toronto. In a long-awaited report, the commission found Metro Toronto’s $3billion hospital system to be riddled with duplicated services, excess capacity, aging buildings and an unduly high concentration of services in the downtown core. To remedy the situation, it proposed radical surgery—the outright closure of 10 hospitals, the transformation of two others into outpatient clinics, and the merger, modification or consolidation of programs at virtually every remaining institution in the system. Few of the 54,000 employees are likely to remain untouched by the proposed changes. Hundreds, perhaps thousands, of jobs may be eliminated outright. ‘There will be some difficult times ahead,” acknowledged Sinclair, a former dean of medicine at Queen’s University in Kingston, Ont., as he unveiled the commission’s findings. “But if we don’t act to restructure and save our health services today, they won’t be available tomorrow.”

Money, or rather the lack of it, is the central problem. Like many other provinces in the country, Ontario is suddenly confronting the unwelcome reality that it can no longer maintain hospitals while the

Too many empty beds are forcing change

actual beds in those institutions continue to disappear because of budget cutbacks. As of last March, there were 6,173 acute-care beds in Metro Toronto’s hospital system compared with roughly 11,000 a decade earlier. Across Ontario, 9,000 beds have vanished, the equivalent of 30 medium-sized hospitals. Yet during the same time, not a single hospital has closed in the Toronto area or, for that matter, in the whole province. “The beds are gone,”

Ontario Health Minister Jim Wilson said last week. “The wards are empty. Sinciair: 7here wm be But the administration is still there.

We’re spending millions to maintain half-empty buildings.” Several other provincial jurisdictions have already reached similar conclusions. Saskatchewan, which once boasted the country’s highest ratio of hospital beds per capita (4.63 for every 1,000 people), was among the first to embark on a comprehensive program of hospital closures. In the past 2 V2 years, 53 rural

hospitals have been shut down and converted into health centres by Premier Roy Romanow’s government. In H the fall of 1998, the 189-bed Plains Æ Health Centre in Regina, the newest of ^^^k the provincial capital’s three acute-care hospitals, will close. Next door in Alberta, three hospitals have been shut down by Premier Ralph Klein’s government and a fourth—the 400-bed Bow Valley Centre—is scheduled for closure next month. Manitoba is gradually turning the 224-bed Misericordia Hospital in Winnipeg into a community health centre. Newfoundland is scheduled to close two hospitals by 1999.

In a precursor to what is now happening in Ontario, hospital services and health-care delivery systems in neighboring Quebec underwent a dramatic reorganization last April when Premier Lucien Bouchard’s government launched what it described as a “virage ambulatoire”—a turn away from traditional hospital care towards ambulatory or home care. The aim of the virage is to reduce the length of hospital stays and increase the use of day surgery. The goal is to close seven of the province’s 121 hospitals and 4,000 of its 23,000 hospital beds by 1998. In line with this program, six Montreal hospitals—two English and four French—have already closed or are in the process of closing, and a dozen more across the province have been or will be transformed into long-term geriatric-care centres and stripped of most of their specialty services, complete with staff and equipment.

Inevitably perhaps, language has become an issue in both Quebec and just across the Ottawa River in the nation’s capital. Sectors of Montreal’s anglophone community view the closure of two of the city’s English hospitals as another act of vengeance by the separatist Parti Québécois government. Mirroring that is the current white-hot controversy surrounding the Sinclair commission’s decision

to recommend the closure The birthing unit at 0f Ottawa’s Montfort Hospi-

Women’s College Hospital: tal, the only entirely French-

medical innovator speaking hospital in On-

difficult times ahead’

CANADA

tario. When the restructuring commission announced the recommendation late in February, it immediately ignited a fire storm of francophone protest, none of it assuaged by the fact that it took four days for the commission to produce a French translation of the decision. Prime Minister Jean Chrétien and Bouchard have been drawn into the fray, with Chrétien expressing his “disappointment” at the move and Bouchard terming it an “irreparable mistake” that calls into doubt the “fundamental question of linguistic rights” in Canada. Both Chrétien and Bouchard personally asked Ontario Premier Mike Harris to intervene. Harris, in response, dismissed both requests, describing Chrétien’s move as being motivated by “election politics” and Bouchard’s by his separatist constituency. As for commission chairman Sinclair, he vowed to remain aloof. “If we were to allow such political issues to influence our decisions,” he coolly stated in the midst of the Montfort controversy, “then what would be the purpose of having a commission in the first place?”

Despite such remarks, some observers note that Sinclair well understands the political game. “His entire report on Metro Toronto is very politic in the way it handles certain constituencies,” maintained Georgina Feldberg, director of York University’s

Centre for Health Studies. The most glaring example, critics say, is the commission’s delicate handling of the politically powerful concentration of hospitals in and around the city’s University Avenue. While wholesale closures and mergers are proposed elsewhere, Mount Sinai, Princess Margaret and the Toronto Hospital are merely directed to join the University of Toronto in establishing a Joint University Avenue Hospitals Task Force to search for ways to consolidate programs and services. The Hospital for Sick Children, perhaps the best-known of the University Avenue institutions, has been earmarked to lead a new Child Health Network to co-ordinate the reorganization of neonatal and pediatric services. No matter what the politics, the Sinclair commission has already accomplished one profound goal. Health care in Toronto—and throughout the province—stands on the brink of dramatic change. □

Isl Post your opinion on hospital closings in the This Week section of the Maclean’s Forum (www.canoe.ca/macleansJ

HOSPITAL CLOSURES BY PROVINCE

BRITISH COLUMBIA: one

hospital closed ALBERTA: three hospitals closed, another closing in April

SASKATCHEWAN: 53 rural hospitals converted to community health centres, one Regina hospital to close in 1998 MANITOBA: no closures yet, but one Winnipeg hospital is

in the process of becoming a community health centre ONTARIO: 24 closures announced so far, with more to come QUEBEC: seven hospitals to close by 1998 NEW BRUNSWICK, NOVA SCOTIA and PRINCE EDWARD ISLAND: no closures NEWFOUNDLAND: two hospitals to close by 1999